Gastric ulcers: malignancy yield and risk stratification for follow-up endoscopy

Background and study aim: Malignant change can occur in gastric ulcer but guideline recommendations for follow-endoscopy (FU-OGD) are conflicting. This study aims to determine rate of malignancy and need for follow-up for gastric ulcers. Patients and methods: Patients with a first diagnosis of gastric ulcer between January 2012 and September 2013 were studied by analyzing endoscopic assessments, dysplasia, and malignancy yield and the influence of risk factors on the likelihood of benign disease. Results: In a cohort of 432 patients with gastric ulcer (53 % male, mean age 65 years) dysplasia or neoplasia were found in 27 (19 adenocarcinomas, 2 cases of dysplasia, 5 lymphomas, 1 melanoma; malignancy yield 6 %). Twenty-five (93 %) cases were diagnosed on first biopsy. The cancer yield of FU-OGD after initially benign biopsy was 0.9 %. Binary logistic regression analysis revealed that endoscopically benign appearance (odds ratio 0.004 95 % CI 0 – 0.576; P = 0.029), benign histology on first biopsy (odds ratio 0 95 % CI 0 – 0.39; P = 0.011) and lower number of ulcers (odds ratio 0.22 (95 % CI 0.05 – 0.99); P = 0.049) were independent predictors of benign disease. All dysplastic and neoplastic cases would have been identified by a combination of initial biopsies plus repeat endoscopy with further biopsies for endoscopically suspicious appearances. Conclusions: In this large cohort 6 % of gastric ulcers were found to be malignant, highlighting the need for all gastric ulcers to be biopsied. The cancer yield of FU-OGD after benign biopsies was low. We have demonstrated that the combination of benign index histology and no endoscopic suspicion of malignancy can predict benign disease. We recommend that all gastric ulcers to be biopsied. Risk stratification could potentially reduce need for FU-OGD

Value of epidermal growth factor receptor status compared with growth fraction and other factors for prognosis in early breast cancer.

The epidermal growth factor receptor (EGFR) is a transmembrane glycoprotein whose expression is important in the regulation of breast cancer cell growth. The relationship between EGFR status (determined by an immunocytochemical assay) and various prognostic factors was investigated in 164 primary breast cancers. Overall 56% of tumours were EGFR-positive and the expression of EGFR was unrelated to axillary node status, tumour size and histological grade; and it was poorly associated with the tumour proliferative activity measured by Ki-67 immuno-cytochemistry. The relapse-free survival (RFS) probability at 3-years was significantly worse for patients with EGFR positive tumours (P = 0.003) and for those whose Ki-67 score was > 7.5% (P = 0.0027), as well as in patients with axillary node involvement (P = 0.01) and with poorly differentiated tumours (P = 0.04). Immunocytochemical determination of EGFR and cell kinetics gave superimposable prognostic information for predicting RFS with odds ratios of 3.51, when evaluated singly. In our series of patients EGFR, Ki-67 and node status retain their prognostic value concerning RFS in multivariate analysis. The 3-year probability of overall survival (OS) was significantly better in node-negative patients (P = 0.04) and was similar in EGFR-positive and negative patients. In conclusion, EGFR status appears to be a significant and independent indicator of recurrence in human breast cancer and the concomitant measurement of the tumour proliferative activity seems to improve the selection of patients with different risks of recurrence

The Relative Importance of Different Trophic Pathways for Secondary Exposure to Anticoagulant Rodenticides

Secondary exposure of predators to anticoagulant rodenticides, and in particular second generation anticoagulant rodenticides (SGARs), is a global phenomenon. The widespread and large-scale nature of this exposure has attracted considerable concern, although the consequences in terms of likelihood of poisoning of individuals and resultant impacts on populations are not well characterised. Secondary exposure of predators may as rise from once or more of: (i) eating contaminated commensal rodents subject to control (target species are typically rats and house mice); (ii) consumption of contaminated non-target small mammals (such as Peromyscus, Microtus, and Apodemus species) that encounter and feed on what are rodent-attractive baits; (iii) consumption of non-rodent vertebrate and invertebrate prey that may also incidentally encounter and eat baits. We hypothesised that predators feeding primarily on target species may be most at risk of exposure to SGARs while those predominantly taking non-mammalian prey may be at least risk. We tested this hypothesis by comparing exposure, determined from the presence and magnitude of SGAR liver residues, in red kites (Milvus milvus), which feeds extensively on rats, in barn owls (Tyto alba), kestrels (Falco tinnunculus), and tawny owls (Strix aluco) that feed widely on non-target small mammals, and in sparrowhawks (Accipiter nisus) that feed predominantly on small birds. We found that the scale and magnitude of exposure was broadly consistent with our hypothesis, and that controlling for age in the analysis could be important as older birds can accumulate residues with age. However, exposure in kestrels was typically greater than that in barn owls and tawny owls, despite what is thought to be a general similarity among the species in their diets. We discuss the relative importance of trophic pathways relative to other factors that may drive secondary exposure in predators, and confirm that species that feed on rats or other target species may be at most risk of exposure and poisoning

Project MOSI: rationale and pilot-study results of an initiative to help protect zoo animals from mosquito-transmitted pathogens and contribute data on mosquito spatio–temporal distribution change

Mosquito-borne pathogens pose major threats to both wildlife and human health and, largely as a result of unintentional human-aided dispersal of their vector species, their cumulative threat is on the rise. Anthropogenic climate change is expected to be an increasingly significant driver of mosquito dispersal and associated disease spread. The potential health implications of changes in the spatio-temporal distribution of mosquitoes highlight the importance of ongoing surveillance and, where necessary, vector control and other health-management measures. The World Association of Zoos and Aquariums initiative, Project MOSI, was established to help protect vulnerable wildlife species in zoological facilities from mosquito-transmitted pathogens by establishing a zoo-based network of fixed mosquito monitoring sites to assist wildlife health management and contribute data on mosquito spatio-temporal distribution changes. A pilot study for Project MOSI is described here, including project rationale and results that confirm the feasibility of conducting basic standardized year-round mosquito trapping and monitoring in a zoo environment

Employment mobility in high-technology agglomerations: the cases of Oxfordshire and Cambridgeshire

This paper examines labour market behaviour of the highly skilled in high-tech local economies, taking the UK examples of Oxfordshire and Cambridgeshire as case studies. It reports on data from a survey of members of three scientific institutes to compare rates of employee mobility in the two locations and considers the likely explanations and implications of those patterns